AOTA Files Comments on Essential Health Benefits Proposed Rule

AOTA submitted a comment letter on December 24, 2012 to the U.S. Department of Health & Human Services (HHS) identifying our concerns with, and suggesting specific changes to, the essential health benefit (EHB) proposed rule. AOTA also signed onto the letters of certain allied organizations such as the Habilitation Benefits Coalition and the Consortium for Citizens with Disabilities. In addition, AOTA worked with state OT associations to encourage the submission of their own comment letters, and approximately a dozen state associations did so.

AOTA’s comment letter addressed the following concerns (link to the full letter below).

1. It appeared from the proposed rule that HHS, and perhaps some states, were treating coverage for habilitative services as a component of rehabilitative services. We argued that the EHB requires distinct coverage of both types of services.

2. We were concerned that some states may only require coverage of pediatric habilitative services, so we urged that the federal rule reflect that adult services should also be covered.

3. The proposed rule, under certain circumstances, would have allowed health insurance issuers to define how habilitative services would be covered. We identified the alternative of creating a default option that would ensure parity of coverage between rehabilitative and habilitative services.

4. Of all the EHBs, the proposed rule only requires an exceptions process for prescription drug coverage. We asserted that the unique nature of habilitative services, i.e., as a new benefit for most of the commercial market, also warrants an exceptions process.

5. The letter also addressed a technical issue regarding state benefit mandates and circumstances under which states may have to defray the cost of them. Essentially, we argued that states should be permitted to define habilitative services without incurring a financial penalty.

6. Finally, we explained why we believe benefit substitution should be prohibited by default, only to be permitted within benefit categories should states take specific action to allow it.

AOTA will continue to monitor implementation of the EHB, and we will continue to work with state associations to advocate for the profession.